recognize the existence of diphtheria and to be in a position to employ without delay the specific remedy. In this respect the city physician is at a distinct advantage in treating diphtheria as compared with his brother in the country districts, although the latter may be often his equal, perhaps his superior in individual ability. Both as regards the early diagnosis of diphtheria and the speedy procuring of reliable antitoxin the city practitioner occupies a position of vantage. Whether the city physician always avails himself of his superior opportunities is another matter. The opportunities certainly exist, and with the development sure to take place in the efficiency of municipal laboratories, the perfection of telephone and messenger service and the establishment of stations for the delivery of antitoxin, the balance is likely to turn even more in his favor. Individual ability and special training in the use of the microscope will sometimes enable a country physician to obtain the necessary information for himself, but in accordance with the laws of specialization, such tasks in the larger towns will devolve more and more upon the expert who devotes his whole time to the work.
The same tendency is at work in other directions. The scope of municipal laboratory work is evidently broadening with the advance of scientific medicine, and. new fields of activity are continually opening before it. In the diagnosis of malarial fever and typhoid fever and in the early recognition of consumption it is already rendering valuable aid to the busy city practitioner. The actual degree of usefulness of the municipal laboratory to the community is still made the shuttlecock of local political conditions, but this stage can last only so long as the city dweller continues to close his eyes to the part that might ]ye played by the laboratory in securing and safeguarding the public health.
There are at least two particulars in which the city is still at a conspicuous disadvantage as compared with the country. These are, first, the high infant mortality, and second, the greater prevalence of various infectious diseases.
As regards the first of these, it is well known that there is a clearly established relation between infant mortality and city milk supply. The richness of milk in those very substances that render it valuable as a food is a source of danger. Not only children but microbes find milk an exceptionally nutritious food. It is not surprising that milk that is at the start carelessly collected and carelessly handled and then carried a long distance should often swarm with countless microorganisms by the time it is delivered to the consumer. In hot weather the growth of bacteria in milk is especially rapid, and much of the milk that is distributed in cities during the summer season is far advanced in the process of decomposition. The high death rate among bottle-fed infants during the summer months, and the traditional popular dread of the 'second summer' as a critical period in infant development are directly traceable to the use of stale milk. The evil is by no means
